Journal of endourology最新文献

{"title":"Ureteroureterostomy for the Management of Non-Neoplastic Distal Ureteral Lesions: A New Challenger of Care in the Era of Robotic Surgery?","authors":"Eleonora Rosato, Roberto Miano, Antonio Pastore, Andrea Fuschi, Luca Orecchia, Thierry Piechaud, Richard Gaston, Anastasios D Asimakopoulos","doi":"10.1089/end.2024.0735","DOIUrl":"10.1089/end.2024.0735","url":null,"abstract":"<p><p><b><i>Background:</i></b> Iatrogenic lesions of the distal ureter represent a frequent and feared complication of abdominal surgery that is traditionally managed by ureteral reimplantation. The aim of this systematic review (SR) is to summarize the published literature on the role of minimally invasive ureteroureterostomy (UU) in the surgical treatment of non-neoplastic distal ureteral lesions. <b><i>Methods:</i></b> We performed a comprehensive literature search on PubMed, Embase, and Cochrane CENTRAL including published peer-reviewed studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The intra-, peri-, and postoperative outcomes as well as the safety profile and the success rates of minimally invasive UU are presented. <b><i>Results:</i></b> Seven retrospective studies with 116 patients were included in this SR. If the basic principles of the ureteral reconstructive procedure are followed, both laparoscopic and robotic UU are feasible, safe, and with a success rate ranging between 81.8% and 100%, depending on the definition of success. A single comparative study documented a significant difference in operative time and length of hospitalization in favor of robotic UU. The success of both laparoscopic and robotic UU has been mainly evaluated in the short and intermediate follow-up. <b><i>Conclusion:</i></b> Minimally invasive UU may represent a viable treatment option for the treatment of non-neoplastic distal ureter pathology such as iatrogenic injuries or radiotherapy-induced stenosis. Larger, prospective studies adopting a standard definition of the postoperative success are required to affirm UU as a first-line option in the management of benign distal ureteral lesions.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"157-165"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of Ultrasonography-Guided Percutaneous Nephrolithotomy for the Management of Pediatric Urolithiasis.","authors":"Yang Hong, Luping Yu, Xiaobo Huang, Lizhe An, Liulin Xiong, Tao Xu, QingQuan Xu","doi":"10.1089/end.2023.0771","DOIUrl":"10.1089/end.2023.0771","url":null,"abstract":"<p><p><b><i>Objectives:</i></b> This study aims to assess the outcomes of ultrasonography (US)-guided minimally invasive percutaneous nephrolithotomy (PCNL) in the treatment of pediatric urolithiasis. <b><i>Methods:</i></b> A retrospective analysis was conducted on 176 patients with pediatric renal and upper ureteral lithotripsy who underwent PCNL between August 2006 and July 2022. The cohort comprised 110 men and 66 women, with ages ranging from 6 months to 16 years. Postoperative stone clearance was evaluated using kidney, ureter, and bladder radiograph or US, categorizing stones less than 4 mm as clear. Postoperative complications were graded according to the Clavien-Dindo classification, with grades I and II considered minor and III and IV classified as major. <b><i>Results:</i></b> Among the patients, 152 underwent unilateral renal operation, whereas 24 underwent bilateral renal operation. The average operation duration was 67.41 minutes (range: 15-195 minutes). The mean duration of nephrostomy tube removal was 3.79 days, and the mean postsurgical hospital stay was 5.97 days. A total of 146 patients experienced a decrease in hemoglobin concentration post operation, with an average drop of 10.57 g/dL (range: 0.5-37.8 g/dL). Initial stone-free rate (SFR) was achieved in 85.5% (171/200) of cases, and the final SFR was 92.50% (185/200). The postoperative rate of minor complications was 8.54% (17/199), whereas major complications occurred in 12.06% (24/199) of cases. During the 6-month to 11-year follow-up period, 19 patients presented with combined stones, and of these 4 presented with ipsilateral stone recurrence who underwent PCNL treatment. Calcium oxalate was identified as the most common stone component. <b><i>Conclusions:</i></b> US-guided minimally invasive PCNL demonstrated excellent SFR and an acceptable complication rate in the management of pediatric urolithiasis. Furthermore, it offers the advantage of minimizing potential risks associated with radiation exposure during the procedure.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"146-150"},"PeriodicalIF":2.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No Injury Observed in Kidneys Treated with Burst Wave Lithotripsy in Therapeutically Anticoagulated Pigs.","authors":"Thomas M Shelton, Bret A Connors, Marcelino E Rivera, James E Lingeman, Michael R Bailey, James C Williams","doi":"10.1089/end.2024.0466","DOIUrl":"https://doi.org/10.1089/end.2024.0466","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Current American Urological Association guidelines recommend that patients with acute obstructive kidney stone requiring continuous anticoagulation/antiplatelet therapy should not be treated by shockwave lithotripsy or percutaneous nephrolithotomy because of the risk of catastrophic renal hemorrhage possible with those techniques. Currently, ureteroscopy is the only recommended surgical treatment. We evaluated if burst wave lithotripsy (BWL) could be used in these cases by treating pigs with BWL while undergoing anticoagulation therapy. <b><i>Materials and Methods:</i></b> Six pigs (31-37 kg) were given 200 units/kg porcine heparin, and then the right kidney of each animal was treated with a dose of BWL (18,000 ultrasound pulses at 10 Hz, 20 cycles/pulse, peak positive pressure of 12 MPa) known to fracture kidney stones. The contralateral kidney served as a control. Therapeutic anticoagulation was confirmed by evaluating activated partial thromboplastin time (aPTT). Microhematuria was checked by urine test strips. Kidneys were subsequently evaluated for hemorrhagic injury via MRI. <b><i>Results:</i></b> aPTT was significantly elevated (>100 seconds) throughout the entire treatment period (<i>p</i> = <0.001) indicating therapeutic anticoagulation. Gross hematuria was not observed in any of the pigs. After BWL, microhematuria averaged 145.8 red blood cells (RBC)/μL in the BWL-treated kidney and 48 RBC/μL in the control kidneys, and there was no statistically significant difference noted in microhematuria rates between the two groups (<i>p</i> = 0.16). Hemorrhagic injury measured only 0.10 ± 0.02% of the tissue in the BWL-treated kidneys and 0.12 ± 0.04% in the control side, with a paired difference of -0.03 ± 0.05%, showing no significant difference (<i>p</i> = 0.58). <b><i>Conclusions:</i></b> A typical clinical dose of BWL causes no hemorrhagic injury to the kidney even during therapeutic anticoagulation therapy. This result suggests that BWL should be safe to use in patients with stone undergoing anticoagulation/antiplatelet therapy.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Analysis of Safety and Efficacy Between Anterior and Posterior Calyceal Entry in Supine Percutaneous Nephrolithotomy.","authors":"Anna Ricapito, Kavita Gupta, Ziv Savin, Kasmira R Gupta, Christopher Connors, Raymond Khargi, Alan J Yaghoubian, Blair Gallante, William M Atallah, Mantu Gupta","doi":"10.1089/end.2024.0508","DOIUrl":"10.1089/end.2024.0508","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> One advantage of supine percutaneous nephrolithotomy (sPCNL) is the ability to access anterior as well as posterior calyces, but the safety and efficacy of anterior calyceal entry has never been investigated to our knowledge. We prospectively evaluated patients scheduled for sPCNL comparing anterior and posterior calyceal access. <b><i>Materials and Methods:</i></b> After Institutional Review Board approval, we prospectively enrolled 100 consecutive patients undergoing sPCNL from February to September 2023. Primary outcomes included intraoperative complications, blood transfusions, 30-day complication rates, and emergency department (ED) visits or readmissions. Secondary outcomes included stone-free rates (SFR). <b><i>Results:</i></b> Seventy-six patients had anterior calyceal entry and 24 had posterior. No significant differences were found in terms of baseline demographics (age, body mass index), stone characteristics (location, density, complexity), or intraoperative features (operative time, location of access). Safety outcomes, including intraoperative complications (1% <i>vs</i> 4%), blood transfusions (3% <i>vs</i> 8%), 30-day complication rates (17% <i>vs</i> 21%), and ED visits (1% <i>vs</i> 0) or readmissions (11% <i>vs</i> 21%) were comparable between groups. Overall SFRs were equivalent (86% <i>vs</i> 90%). <b><i>Conclusion:</i></b> We found that anterior and posterior accesses in sPCNL offer similar safety and efficacy, with no significant differences in complications or SFRs. Surgeons can select either approach based on patient anatomy and surgical needs without concern for increased complications. Further research is necessary to confirm these findings and guide best practices for calyx selection in sPCNL.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"19-25"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal Pelvis Urine Sampling in Patients with Obstructed, Infected Ureterolithiasis: A Retrospective Quality Improvement Initiative.","authors":"Majid Mirzazadeh, Raymond Xu, Collette O'Connor, Parth U Thakker","doi":"10.1089/end.2024.0179","DOIUrl":"10.1089/end.2024.0179","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Patients who present with urinary tract infections secondary to obstructing stones occasionally fail to improve on treatment based on midstream urine culture (MUSCx). Varying microbiomes between the bladder and the renal pelvis may account for this. In this study, we sought to investigate the utility of obtaining a renal pelvis urine culture (RPUCx) at the time of stenting to guide antibiotic treatment prior to definitive stone operation. <b><i>Materials and Methods:</i></b> RPUCx was obtained in 257 patients presenting with obstructive ureteral stones undergoing emergent stenting. Concordance rates of RPUCx to MUSCx and blood cultures were examined. Operative time and infectious complication rates after definitive stone management between the two groups were studied. A comparison of those who received an intraoperative RPUCx with those who did not was carried out. <b><i>Results and Conclusions:</i></b> RPUCx was obtained in patients undergoing emergent stenting from 2018 to -2021; 31% (52/168) of patients had pathogens in the renal pelvis that were absent in the MUSCx. RPUCx had a greater concordance rate with blood culture results compared with MUSCx (95% <i>vs</i> 50%). Drawing RPUCx intraoperatively did not significantly change operative time (15.9 <i>vs</i> 13.6 minutes, <i>p</i> = 0.15). Treatment tailored to RPUCx resulted in lower rates of post-stone management complications (odds ratio 0.26, 95% confidence interval = 0.08-0.83; <i>p</i> = 0.01). RPUCx at the time of stenting can guide treatment and decrease post-treatment complications without additional operative time, confirming utility in the treatment of patients with infection secondary to obstructing stones.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"79-83"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longer Preoperative Antibiotic Duration Prior to High-Risk Ureteroscopy Does Not Decrease Infectious Complications.","authors":"Wilson Sui, Heiko Yang, Lejla Pepic, Kevin Chang, Kevin Shee, Ukrit Rompsaithong, David B Bayne, Marshall L Stoller, Thomas Chi","doi":"10.1089/end.2024.0487","DOIUrl":"10.1089/end.2024.0487","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Postoperative infections after ureteroscopy are common and potentially devastating complications. National and international guidelines recommend treatment of symptomatic positive urine cultures prior to operation, but how to manage patients with asymptomatic colonization remains unclear. In clinical practice, there is wide variation in the choice and duration of antibiotics for these patients. To examine how preoperative antibiotic duration impacts postoperative infection rate, we evaluated our institutional practices and outcomes. <b><i>Materials and Methods:</i></b> Our prospectively collected database was queried for patients undergoing ureteroscopy between 2015 and 2023. Preoperative urine culture results and antibiotic duration/choice were abstracted. Patients included for study were those with a high risk of urinary colonization defined as those with history of neurological insult, bowel diversion, indwelling suprapubic catheter or foley, or a stent/nephrostomy. Our primary outcome was postoperative infection, defined by urinary tract infection (UTI), pyelonephritis, systemic inflammatory response syndrome (SIRS), or fever within 30 days of operation. <b><i>Results:</i></b> A total of 405 patients met our inclusion criteria. Preoperative prophylactic antibiotics were not utilized in 68% of the study cohort, while 11% received less than 3 days or 3-10 days of prophylaxis and the remaining 10% received more than 10 days. The overall rate of UTI or pyelonephritis was 9%, and the SIRS or sepsis rate was 5%. Although receipt of preoperative prophylactic antibiotics of any duration was not predictive of postoperative infectious complications on multivariable analysis, women were associated with a 4.135 (OR: 1.768-9.669, <i>p</i> = 0.001) increased odds of UTI/pyelonephritis compared with men. <b><i>Conclusions:</i></b> In high-risk patients, the duration of preoperative antibiotics prior to ureteroscopy did not reduce postoperative infectious complication rates. Women were the only clinical feature associated with increased risk of UTI/pyelonephritis. Further research is needed to identify alternative interventions to prevent postoperative infectious complications.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"34-41"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Comment on END-0682-OR.R1.","authors":"Jinna Yao, Henry H Woo","doi":"10.1089/end.2024.0781","DOIUrl":"10.1089/end.2024.0781","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"71-72"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Safety and Feasibility of Aquablation in Patients with Previous Surgery for Benign Prostatic Hyperplasia.","authors":"Desiree E Sanchez, Alireza Ghoreifi, Lorenzo Storino Ramacciotti, Jie Cai, Marissa Maas, Abhishek Venkat, Randall Lee, Andre Luis Abreu, Giovanni E Cacciamani, Leo Doumanian, Inderbir Gill, Andrew Liu-Chen, Mike Nguyen, Rene Sotelo, Mihir M Desai","doi":"10.1089/end.2024.0370","DOIUrl":"10.1089/end.2024.0370","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Aquablation for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) has been adopted to treat a wide range of prostate anatomies including glands up to 150 cc. Patients with recurrence of LUTS after previous BPH procedure often present with variant anatomy, and a paucity of literature exists on the optimal treatment modality for these patients. Herein, we evaluate the safety and feasibility of aquablation in patients with previous BPH surgical history. <b><i>Patients and Methods:</i></b> A prospectively managed single institution database of aquablation patients with BPH/LUTS was queried from August 2020 to December 2022 for patients who failed previous BPH procedures. Patients were divided into two groups: those with and without previous BPH procedure. Primary outcomes were intraoperative and 90-day complications. Secondary outcomes included operative time (OT), number of Aquabeam passes, estimated blood loss, hospital length of stay, and catheter duration. Outcomes were assessed using chi-squared, Wilcoxon rank sum tests, and logistic regression. <b><i>Results:</i></b> A total of 200 patients with BPH/LUTS were treated with aquablation. We identified 26 patients with a history of previous BPH procedures. Patients who underwent previous BPH procedures had smaller prostate volumes (60 cc) compared with treatment-naïve (88 cc) patients, <i>p</i> = 0.016. There was no difference in perioperative and 90-day complications (29% for treatment-naïve <i>vs</i> 17% in the retreatment group, <i>p</i> = 0.32). Most secondary outcomes were the same including OT, but the retreatment group had fewer Aquabeam passes (2 [1-2] <i>vs</i> 2 [2-2] treatment-naïve, <i>p</i> = 0.037) and more additional procedures at follow-up (30% <i>vs</i> 8.3% treatment-naïve, <i>p</i> = 0.005). <b><i>Conclusion:</i></b> Patients with previous BPH interventions remain excellent candidates for aquablation, with similar perioperative and 90-day postoperative outcomes compared with intervention-naïve patients. Aquablation demonstrates efficient tissue ablation without the risk of increased injury or significant blood loss after prior failed BPH procedures.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"50-55"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Outcomes of En-Bloc Holmium Laser Enucleation of the Prostate and Transvesical Robot-Assisted Simple Prostatectomy for the Management of Benign Prostatic Hyperplasia: A Propensity-Matched Analysis.","authors":"Manish Kumar Choudhary, Kaushik P Kolanukuduru, Ahmed Eraky, Almoflihi Mohammed, Neeraja Tillu, Hannah Sur, Lianne Ohayon, Arjun Venkatesh, Arshia Rangchi, Zachary Dovey, Osama Zaytoun, Maurizio Buscarini","doi":"10.1089/end.2024.0601","DOIUrl":"10.1089/end.2024.0601","url":null,"abstract":"<p><p><b><i>Background:</i></b> Holmium laser enucleation of the prostate (HoLEP) and robot-assisted simple prostatectomy (RASP) have emerged as the two surgical treatments of medication-refractory benign prostatic hyperplasia (BPH). The comparative outcomes of en-bloc HoLEP with early apical release and RASP with modified Freyer's technique remain unexplored. <b><i>Methods:</i></b> Between 2018 and 2022, patients with medication-refractory BPH and prostate volume ≥80 g underwent HoLEP or RASP depending on clinical characteristics, patient choice, and surgeon preference. A 1:1 propensity-matched analysis was performed with prostate volume and preoperative International Prostate Symptom Score (IPSS) as the matching variables to eliminate selection bias. Trifecta outcome was defined as complete urinary continence, <i>Q</i>_max >15 mL/second, and no postoperative complications at 3 months. After an initial univariable analysis to predict factors associated with the trifecta outcome, variables with significance levels of ≤0.1 were included in a multivariable model. <b><i>Results:</i></b> Of 416 patients with medication-refractory BPH, 158 underwent HoLEP, whereas 258 underwent RASP. Following matching, 80 patients in each group were included in the analysis. There was no difference in the median postoperative IPSS score, median postoperative <i>Q</i>_max, and continence rate at 3 months. The percentage of patients who attained the trifecta outcome in the HoLEP and RASP groups was 71.25% and 63.75%, respectively (<i>p</i> = 0.4). Patients in the HoLEP group had shorter postoperative stay (HoLEP: 1 [IQR 1-2] <i>vs</i> RASP: 2 [IQR 1-2], <i>p</i> = 0.04) and catheterization time (HoLEP: 2 [IQR 1.75-3] <i>vs</i> RASP: 5 [IQR 5-5], <i>p</i> < 0.001). A multivariable regression did not identify any factors predictive of trifecta outcomes. <b><i>Conclusion:</i></b> Given its comparable efficacy to RASP, HoLEP is the preferred treatment for BPH in large prostates because of its shorter hospital stay and catheterization time. Future randomized controlled trials are required to solidify indications for these treatment modalities and standardize treatment protocols for patients with medication-refractory BPH.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"57-63"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Two Different Approaches in the Drainage of the Upper Urinary Tract in \"Acute Obstructive Uropathy\": A Critical Evaluation.","authors":"Ferhat Yakup Suçeken, Murat Beyatlı, Samet Güngör, Hakan Karaca, Eyüp Veli Küçük, Kemal Sarıca","doi":"10.1089/end.2024.0242","DOIUrl":"10.1089/end.2024.0242","url":null,"abstract":"<p><p><b><i>Aim:</i></b> To compare the results of retrograde ureteral stent (RUS) and percutaneous nephrostomy (PCN) procedures for decompression in patients with acute obstructive pyelonephritis. <b><i>Patients and Methods:</i></b> Medical records of patients undergoing PCN or RUS for emergency urinary diversion because of obstructive pyelonephritis were evaluated retrospectively. Patients with urinary tract obstruction and concurrent fever (≥38°C), pyuria, and costovertebral angle tenderness were included and divided into two groups based on the type of emergency urinary drainage applied (PCN in Group 1) and (RUS in Group 2). Apart from the demographic data and Charlson Comorbidity Index, laboratory and radiologic examination outcomes were well evaluated. <b><i>Results:</i></b> A total of 155 patients including 73 patients (47.1%) undergoing PCN (Group 1) and 82 patients (52.9%) undergoing RUS (Group 2). Although no significant difference was found regarding the demographic characteristics, the operation time, as well as fluoroscopy time, was significantly shorter in Group 1 cases when compared with those in Group 2 (<i>p</i> < 0.0001). The success rate was similar between the two groups, and there was also a significant difference regarding the complication rates in both groups of cases (5.5% <i>vs</i> 7.3%). <b><i>Conclusions:</i></b> Our findings showed that despite similar efficacy and success rates noted between PCN and RUS applications in the emergency drainage of cases presenting with obstructive pyelonephritis, PCN application was found to be advantageous because of shorter operation and fluoroscopy durations. More importantly, this approach was associated with a significantly less need for intensive care during the postoperative period.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"84-89"},"PeriodicalIF":2.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}